Awoke

Boom! The hits just keep comin’: COVID-19 pandemic, police brutality/racial injustice protests, extreme heat, smokey air from wildfires…and a very bullish stock market!

Each day I’m awoke to news of weather (recent heat wave disproved “coldest winter was summer in SF”), Flex Alerts (rotating power outages in evenings, due to reliance on sun and wind power), air quality index (mostly unhealthy), more evidence of climate change, COVID-19 data (though underreported due to statewide backlog), street protests, etc.  

And when I log-on to Blogger, I’m awoke to New Blogger (default) that is supposed to make it easier to use on mobile devices.  But I do not post using my cell phone’s small screen.  For past couple of months, I’ve been sending feedback to Google to please keep Legacy Blogger’s What-You-See-Is-What-You-Get (WYSIWYG) interface, or fix New Blogger interface, which is so buggy and slow. I want Blogger to stay Old=Reliable.

Awoke to ageism

In December 2019 (before COVID-19 pandemic seemed so long ago!), University of Michigan surveyed U.S. residents age 50 to 80: more than 80% reported experiencing ageism, yet they still held positive views on aging with 88% feel more comfortable being themselves, and 80% have a strong sense of purpose. Almost 6 months since World Health Organization (WHO) declared COVID-19 pandemic, ageism also has gone viral…time for an updated survey?! 

According to March 2020 report by Centre for Better Ageing, 1 in 3 people in U.K. reported experiencing ageism. 

Last month’s California for ALL Ages: Virtual Town Hall on Combatting Ageism & Promoting Equity gave me a better understanding of SF’s Reframing Aging campaign, #EndAgeismSF.  Funded by SF Department of Disability & Aging Services (DDAS) and Metta Fund, this campaign is tailored to SF’s diverse population of adults age 60+: 53% speak a primary language other than English (materials also offered in Spanish and Chinese), 29% live with a disability, and 12% identify as LGBTQ; 44% identify as Asian/Pacific Islander, 39% White, 10% Latinx and 6% Black. 

Launched last fall, SF Reframing Aging is a three-phase campaign:

1.   Awaken people to ageism, focusing on ages 30-50

2.   Help older adults recognize implicit ageism and connect with aging resources

3.   Foster intergenerational connections in community and workplace

Phase 1’s awakening campaign was based on April 2019 surveys of people age 30-50, who held mostly “positive views” about older adults in response to what words come to mind when you think of older adults? Wisdom/wise were common themes in word cloud.

However, when asked what words come to mind when you think of becoming older yourself? “More negative words” appeared, suggesting unconscious bias?

In October 2019, SF Reframing Aging launched its website and #NeverGetsOld posters on bus shelters and light poles, as well as postcards and buttons.  Community Living Campaign’s Senior Beat profiled people featured in campaign, “Reframing Aging – ‘Older ≠ Lesser’: City embarks on effort to squash aging stereotypes”:

·       Caring never gets old: Bus stop chats with lonely seniors – of all ethnic backgrounds – fulfill Navajo elder’s ideals (age 67) 

·       Leadership never gets old: Retired youth counselor helped families overcome ‘disconnectedness’ (age 65)

·       Sharing joy never gets old: Bayview woman brings steel drumming and other ‘feel good’ activities to community’s seniors (age 73)

·       Courage never gets old: A journey from drugs and destitution to role in Apple commercial (age 64)

·       Determination never gets old: Energetic knitter who once fled war finds fruitful work and friends in U.S. (age 84)

In these profiles of older people as helpers, men are associated with leadership and courage, while women are associated with sharing joy/creativity, caring/passion, and intelligence/determination. Characterizations that suggest gender stereotypes?  

“Never gets old” theme is repeated in Little Brothers – Friends of Elderly (LBFE)’s website featuring “elder stories” as part of “This Never Gets Old” series, inviting volunteers to meet “Our elders come from all walks of life with stories as beautifully diverse as the Bay Area itself.” 

If Phase 1 campaign is intended to “awaken” people ages 30-50 (millennial, Gen X), guess it’s more relatable to focus on rosy Third Age (privileged demographic of AARP consumers age 50+ or “more hip seniors”) while downplaying (marginalizing) the Fourth Age (frailer, more dependent older people). 

Successful aging = “positive” stereotypes

SF’s campaign is based on FrameWorks Institute’s Reframing Aging initiative, which seeks to “connect representations of successful aging to the implementation of effective social policies” that enable older adults to remain physically active (“vibrant”) and autonomous (“independent”). 

Though FrameWorks doesn’t define “successful aging,” sure sounds like Rowe & Kahn model of successful aging: ability to maintain low risk of disease or disability, high mental and physical function, and active engagement with life.  Like escapist AARP Movies for Grown-Ups, with characters who never seem to grow up or develop beyond romance-seeking sorority sisters in Book Club (2018) and aspiring cheerleaders in age 55+ community in Poms (2019).  Almost like regression to adolescence or younger phase, as in headline “This Stanford Scientist Can Make You Feel And Think Younger: Interview With Dr. Laura Carstensen.”  

“If you look across the world across the 60 countries that have been studied, the peak age of happiness tends to be about 82…your neurochemistry shifts…You realize you've gotten through all these things that were stressing you out. If you make it to 82, you know you've managed you're okay!”—Daniel Levitin, PhD, age 62 (20 more years to peak happiness!), “A neuroscientist lays out the keys to aging well,” PBS Newshour (Jan. 11, 2020) 

The self-help (sometimes anti-aging) book industry has been appealing to this Boomer demographic ad nauseam, with titles like Daniel Levitin’s Successful Aging: A Neuroscientist Explores the Power and Potential of Our Lives (2020), and Nir Barzilai’s Age Later: Health Span, Life Span, and the New Science of Longevity (2020) includes chapter on “Making 80 the New 60”! This month’s American Federation for Aging Research (AFAR) Live Better Longer: Secrets of Superagers Zoom discussion featured Dr. Barzilai, who shared “fascinating case studies of those who live past 100 and the inspiring scientific discoveries that show we can mimic some of their natural resistance to the aging process.” His “superagers” included value investor Irving Kahn, who died at 109 (one month after his son Donald’s sudden death at 79) and his older sister Helen Reichert, who also lived to 109 (just 7 weeks shy of becoming a supercentenarian) and had multiple careers in fashion; both smoked, and Helen said her 4 doctors who told her to stop died. 

Media love to report on supercentenarians, like 113-year-old Lucy Mirigian, 1918 flu pandemic survivor who hopes to make it through COVID-19 pandemic by following SF health orders, staying in SF home that she bought in 1952.  The world’s oldest married couple, 110-year-old Julio Cesar Mora Tapia and 104-year-old Waldramina Maclovia Quinteros Reyes married for 79 years and going strong, shared COVID-19 pandemic advice: “follow the rules with respect and love the life.”

I can’t help but compare flattering portrayals of successful agers to the “positive” stereotype of Chinese model minority raised by Tiger Mom, which has been criticized as racist and masking real difficulties such as poverty and related ills.  If a group is doing so well on its own, no need for government policies to pay attention?  If we want care for frail older people, share their stories!

Healthy aging = functional ability

Where are the more complex stories about what people lose/gain from becoming frail and vulnerable?  Part of the answer may lie with successful aging’s compression of morbidity ideal: postponing chronic illness/functional loss for short period near time of death.  In the dominant biomedical model, this frailty, vulnerability, chronic illness, functional loss, etc. appear as undesirable “negative” stereotypes of aging.  Yet, this is part of the diversity of old age, including many of my clients who are seen and heard by me.  Not to be Debbie Downer, I think there’s more potential for deeper character development when faced with challenges, at any age, if we are honest with ourselves: who am I as a human being when confronted with loss of functional ability? In a capitalist society, what is my value when considered less or no longer “productive”? Dignity (inherent worth) is devalued when greed prevails (as love of money is the root of all evil, 1 Timothy 6:10).  EndAgeism should include EndAbleism!

Gerontologists roughly divide old age into three groups: young-old (65-74), middle-old (75-84), and oldest-old (85+); in 2011, U.S. Census Bureau changed the definition of oldest-old to 90+ because Americans are living longer.  Gerontologists also understand that rather than chronological age, the more important distinction is functional ability (performing activities of daily living that require cognitive and physical well-being). 

WHO launched Decade of Healthy Ageing: “the process of developing and maintaining the functional ability that enables well-being in older age.  Functional ability is about having the capabilities that enable all people to be and do what they have reason to value.”  Healthy Ageing replaced Active Ageing (“process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age”). 

“As people grow older and develop age-related diseases, two of the most common, feared, costly, yet least understood impairments are the loss of mobility and cognition (the ability to think and make decisions). These often mark the onset of frailty and decline… the most effective interventions, including age-friendly home renovations and exercise, can take place in your home or community.”—Geriatrician Lewis A. Lipsitz, MD, “When Iʼm 84: What Should Life Look Like in Old Age?” Journal of the American Geriatrics Society (Mar. 9, 2020) 

In Crip Camp: A Disability Revolution (2020) documentary, Neil Jacobson talked about the hierarchy (layers of social privilege) in disability types, with polio on top because “they looked more normal” and cerebral palsy at the bottom; when he met his future wife Denise, who also had cerebral palsy, his parents asked “why can’t you find a polio?” Similarly, in ageism, there appears to be a hierarchy with “successful” or Third Agers on top, and frailer Fourth Agers at bottom – and people with progressive, degenerative disease like Alzheimer’s and related dementias at the very bottom, often hidden in locked units and vulnerable to bullying/abuse by higher functioning people, or fate of “zombie apocalypse.” 

Ageism/Ableism in Fourth Age

“Not all old lives suffer ageism's blows equally. If the residents of 55+ communities, planned neighborhoods geared toward younger retirees, were dying at the same rate as people in nursing homes, responses would likely take on a greater sense of urgency. The ubiquity of coronavirus-related nursing home deaths reflects a particular permutation on ageism — discrimination not only against old age but also against dependency in old age, most typified by the cognitive limitations associated with dementia.” –Lynn Casteel Harper, “America's deadly ageism: How COVID-19 exposes prejudice against the elderly and dementia patients,” Salon (May 15, 2020)

One wonders if stigmatization of the Fourth Age and long-term care (LTC) facilities enabled neglect of frail older people, exacerbated by COVID-19 pandemic. 

FrameWorks Institute’s Finding the Frame: An Empirical Approach to Reframing Aging and Ageism (2017) recommended these approaches to framing frailty: 

·       Make the case for policies and programs that can prevent or reduce late-life frailty, so society can “reap the benefits of the momentum of experience and wisdom that we accumulate as we age”

·       “remind the public that a just society takes responsibility for equal protection of all Americans, …neglecting the needs of frail Americans is an instance of structural ageism”

FrameWorks cautioned to avoid “sympathetic senior trap” which runs risk of framing all older people as vulnerable and tends to evoke paternalistic thinking, as opposed to systems-level thinking that can lead to policy solutions; use storytelling to focus more on explaining than describing. 

Literary gerontology (e.g., Julian Barnes’ The Lemon Table collection of short stories about old age) allows more insightful perspectives on aging in narratives that reflect awareness of increasing frailty/vulnerability, create meaning of one’s life trajectory, and contribute to wisdom when life lessons are shared. 

  

LTC facilities

“By the way in which a society behaves toward its old people, it uncovers the naked, and often carefully hidden, truths about its real principles and aims… Many societies respect the old so long as they are clear-minded and robust, but get rid of them when they become senile and infirm.”—Simone de Beauvoir, The Coming of Age (1970)

With the current #BlackLivesMatter protests and attention to inequities among BIPOC, wonder if there’s less empathy for LTC residents who are mostly non-Hispanic white, assuming they benefited from lives of white privilege? Here are demographic characteristics of LTC residents (based on 2016 data): 

·       Nursing homes: 75.6% non-Hispanic white; 43.5% women; 85.1% age 65+, 43.5% age 85+

·       Assisted living: 81.4% non-Hispanic white; 70.6% women; 93.4% age 65+, 52.1% age 85+ 

Just like old (age), race is socially constructed, as I was reminded during my stint in LTC facilities serving primarily Jewish residents, who taught me that they were considered colored/non-white until they became more assimilated (“becoming white” as they gained sympathy) after Holocaust, including changing their names (similar to Kahn centenarians Helen and Peter who “Anglicized” name to Keane) and appearances (rhinoplasty).  Residents of Sephardic ancestry mostly identified as Hispanic.  (Pictured above) I invited Aaron Hahn Tapper, University of San Francisco Jewish Studies Professor and author of Judaisms: A Twenty-First Century Introduction to Jews and Jewish Identities (2016), to explore this further with residents, many who felt strongly about staying in a facility that honored their Jewish identity. I found common ground with Jewish residents, perhaps due to diaspora, identifying as “outsiders” in adapting to different environments, including LTC facilities which was their residence but my workplace.

Yet, anti-Semitism persists in white supremacy, and Jewish are excluded in proposed California Ethnic Studies Model Curriculum for high school students (AB 331 limited to African, Asian, Latinx, and Native American identities—similar to AB 1460 for California State University system's undergraduates).  

For a more inclusive society, must require gerontology coursework taught by culturally sensitive experts!

“Why does this lack of literacy on aging and health exist? The US educational system should provide education to the population about gerontology, the study of aging, geriatrics, and health and disease associated with aging…Not only would it help children and youth understand their elders’ behaviors and conditions but it also could promote dignity and a respect for life…

As a society, we can do a much better job of educating our youth and fostering the skills necessary for successful aging… Without education that provides knowledge about how to age successfully and prevent health deterioration, many individuals will be doomed to becoming increasingly frail, possibly bedridden, and unable to perform basic functions of life, such as eating and dressing.”—James C. Siberski & Carol Siberski, “Geriatric Education Today & Tomorrow,” Today’s Geriatric Medicine (Sep/Oct 2019) 

Woops, medicalization of successful aging—as defined by Rowe & Kahn again—is so pervasive. For people in the Fourth Age who are frail, optimal aging based on Baltes’ SOC (Selection, Optimization, Compensation) model might be more relevant. Liang & Luo's harmonious aging model offers a more diverse, inclusive and less ageist perspective to value old age experience.  

Based on a limited analysis in May 2020 by The New York Times, nursing homes where African-American and Latinx made up a significant portion of residents were found twice as likely to have COVID-19 cases than where the population was overwhelmingly white, and regardless of their location, size, government rating; however, this analysis could not determine whether there was racial disparity in rates of illness or death between white and non-white residents due to lack of data. Most direct care workers in LTC facilities are BIPOC.  In July, U.S. Senators requested that CDC and CMS collect and publicly report demographic data on COVID-19 cases and deaths in nursing homes. 

According to Kaiser Family Foundation reports, more than 70,000 residents and staff of LTC facilities have died from COVID-19.  And this is an undercount because the federal government only required nursing homes to submit data of COVID-19 deaths since May; to correct this, Senate introduced Emergency Support for Nursing Homes and Elder Justice Reform Act of 2020, which would require nursing homes to report COVID-19 deaths and other information dating back to January 1.  NY only reported COVID-19 deaths occurring in nursing homes, but not nursing home residents transferred to hospitals where they died.  Further, some residents died without being tested for coronavirus.  Data from assisted living under oversight of states is less consistent and harder to come by.

A KQED investigation found that wildfire is a "significant hazard" at 35% of California's 10,000 LTC facilities, while laws governing emergency preparedness are weak and enforcement is lax, and COVID-19 pandemic has disrupted watchdog efforts and further complicated urgent disaster planning.

On August 25, California DPH updated evolving visitation guidance to require LTC facilities to permit ombudsman to enter, subject to screening for fever and COVID-19 symptoms and wearing mandatory PPE. 

During this COVID-19 pandemic, would be interesting to take a survey to find out how many people wish to age in place? How many desire to move into LTC facilities? How many current residents in nursing home and assisted living facilities want to remain where they are? How many desire to leave, if presented with viable home and community-based options? 

California Master Plan for Aging (MPA) paused for few months due to pandemic, then resumed via Zoom, with public input and recommendations due next month so Governor can issue MPA by December 2020.  This pandemic, given its disproportionately deadly impacts on older people, has made it more urgent to get recommendations “right,” particularly to address systemic inequities, even if this slows the process.  Where the current MPA stands, as of August 11 Stakeholder Advisory Committee meeting, is same old, same old complex and fragmented system that is difficult to navigate.  
During this pandemic, the existing system allowed insurance companies to post record profits by collecting premiums from consumers who postponed in-person care; must read Amanda Holpuch’s “US health insurers doubled profits in second quarter amid pandemic,” The Guardian (Aug. 14, 2020).  We sorely need a system that puts people care above profits! Advocates have called for reform of payment and regulatory system to redesign Long-Term Supports and Services (LTSS) with stronger investment in Home and Community-Based Services (HCBS). 

California Alliance for Retired Americans (CARA), Gray Panthers and Senior & Disability Action (SDA) recommended:

·       statewide universal LTSS system that is affordable to all, covers all who need it, covers all care and supports needed, as long as needed

·       this LTSS system could be integrated in a single-payer Medicare for All, a social insurance program that is funded by a progressive tax on the wealthy and big corporations in combination with a payroll tax, and that includes provisions to invest in training, recruitment and retention of workforce needed to fill the estimated need of 600,000 to 3 million additional paid LTC workers.

Germany and Japan have universal LTC insurance. In Japan, 14% of COVID-19 deaths were in LTC facilities, compared with more than 40% in U.S., despite a lower proportion of U.S. elders living in LTC facilities.  In addition to national LTC insurance, Japan benefits from cultural values prioritizing elderly care, lower rates of diabetes and obesity that are risk factors for COVID-19 deaths. 

Reframing Aging in health care

This month’s Gerontological Society of America (GSA) webinar, Reframing Aging: A Primer for Health Care Professionals, focused on communication choices to talk about older people and health equity.  The examples related to “successful agers” who are productive as essential workers/volunteers and caregivers.

·       When people think health outcomes are only about individual choices, carefully attend to attribution of responsibility: tell systems stories, leave no space in communication to blame marginalized groups instead of inequitable systems; example – “When thinking about higher number of deaths among older Black people and Latinos, we need to think about why people get sick in the first place.  Who still has to leave their home to work, who has to leave a crowded apartment, get on crowded transport, and go to a crowded workplace? The privilege of working from home is not available to everyone.”

·       When people only hear about older people’s vulnerability, tell other stories about older people’s experiences during the pandemic; example – “States such as New York and Florida issued calls for retired medical professionals to return to work, and tens of thousands volunteered to do so.  Likewise, many older people are caregivers for family members who are frail, disabled, or cognitively impaired.”

When talking about nursing home residents, Reframing Aging refers to “high risk” as code for frailty/vulnerability.  To meet the challenge when encountering people who are fatalistic about health outcomes for older people, find balance between urgency and efficacy; example – “Nursing home populations are at a high risk of being infected by – and dying from – the coronavirus.  COVID-19 is known to be particularly lethal to adults in their 60s. A strong infection prevention and control program, however, can protect residents and healthcare personnel.”

Finally, if people dismiss ageism as a serious issue, FrameWorks advises us to talk about intersectionality instead of comparing “isms”; example – “Older people are diverse in many ways including race, ethnicity, socioeconomic status, disability, sexual orientation and gender identity. Addressing marginalization and discrimination in the pandemic must focus on these sources of inequity as well as age.”  

Takeaways from International Federation on Ageing Virtual Town Hall – COVID-19 and Older People: Opportunities to Combat Ageism:

·       Caregivers and those who work alongside older people experience ageism first hand in health care settings, and are important advocates against ageism.

·       Interventions include intergenerational programs; older people modeling “positive ageism”; using “appropriate” language like “older people” instead of ageist terms like “elderly” or “seniors” that segregate older people

This year’s OCA Summit: Resilient Communities, freely made online, included program on COVID-19 and Our Elders, with Isabel Tom, author of The Value of Wrinkles: A Young Perspective on How Loving the Old will Change Your Life (2020), and Denny Chan, senior attorney with Justice in Aging and former OCA intern, discussing their grandparents’ influence and their respective work in LTC facilities and health care advocacy, particularly on behalf of older adults who may be reluctant to speak up about experiencing age discrimination, which leads to underreporting.

Words matter (but no consensus)

Because “words have the power to hurt and heal,” San Francisco State University Journalism Professor Rachele Kanigel published The Diversity Style Guide to help writers with the latest word choices when communicating about diverse communities in the constantly changing language space.  Here’s what she offered for words relating to age: 

·       boomer: describes person born during post-World War II baby boom between 1946 and 1964.  Boomers and boomer generation are preferred over baby boomers, which is perceived as condescending. 

·       elderly: use sparingly, appropriate only in generic phrases that do not refer to specific individuals. “If the intent is to show that an individual’s faculties have deteriorated, the Associated Press Stylebook recommends citing a graphic example and attributing it to someone.”

·       older: preferred descriptor for people in later life

·       senior, senior citizen: use sparingly; preferred term is older adults

In Ageism in America (2006), geropsychiatrist Robert N. Butler and Anti-Ageism Taskforce at the International Longevity Center did not include baby boomer, elderly, old, senior, senior citizen in list of ageist terms (p. 22); used “baby boomers” 8 times in text (not including references); mostly used “older person” and occasionally “old person.”  Word choices have always been important tools in advocacy, and more so in this "New Ageism" during COVID-19 pandemic. 

American Medical Association style guide allows: “Because the term elderly connotes a stereotype, avoid using it as a noun.  When referring to the entire population of elderly persons, use of the elderly may be appropriate (as in the impact of prescription drug costs on the elderly, for example).”   Are strong objections to using the term elderly in frailty context a denial of Fourth Age?

As part of the Leaders of Aging Organizations (LAO) Collaborative that partnered with FrameWorks Institute’s Reframing Aging initiative, GSA and American Geriatrics Society (AGS) adopted specific word choice recommendations in their publications’ style guides.

·       Refer to persons age 65+ using these preferred terms: older persons, older people, older adults; AGS also includes using older patients, older individuals, or the older population. 

·       Avoid using these terms: seniors, elderly, the aged.  AGS also includes avoiding aging dependents, old-old, young-old, and similar “other-ing” terms connote a stereotype.

In a Journal of Geriatric Physical Therapy editorial, a group of physical therapists recommended that the term “elderly” disappear (as done with bygone terms like senile, demented, and aged) because it is ageist, “stereotyping older folks as sick, frail, and physically dependent.” 

Connotations

In Finding the Frame: An Empirical Approach to Reframing Aging and Ageism (2017), FrameWorks Institute’s researchers found a continuum of competence associated with different labels given to people in later life, from least competent (e.g., frail, can’t use computers) to most competent (e.g., independent, wise): senior, elder, senior citizen, older person, older adult.  While acknowledging older adult as the current preferred term among progressive voices in the aging field, this term was associated with someone in their mid-50s.  To advance policies for people older than that, FrameWorks recommended use of term older person, which was associated with someone in late 60s. 

In Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life (2019), UCSF geriatrician Louise Aronson recognized term Senior (chapter 10) under Adulthood, and terms Old, Elderly and Aged (chapters 11, 12, and 13) for distinct groups of old age under Elderhood.  In Life (chapter 1), she described her visit to UC Berkeley Professor Guy Micco’s class, where medical students associated elder with respect, leader, experience, power, money, knowledge – suggesting greater competence, contrary to research by FrameWorks Institute (which placed elder as "least competent" after senior)?!

Is elderly simply a derivative from adding suffix -ly to elder?

According to Free Dictionary’s usage note for “elderly,” its use as a noun is relatively neutral, denoting a group of people in advanced age; however, its use as an adjective has a range of connotations that go beyond denotation of chronological age: 

“On the one hand it can suggest dignity, and its somewhat formal tone may express respect: sat next to an elderly gentleman at the concert. On the other hand, it can imply frailty or diminished capacity, in which case it may sound condescending: was stuck in traffic behind an elderly driver.”

California Department of Aging refers to “elderly” population. In geriatric programs, “the elderly” refers to older people who experience frailty (geriatric syndrome), as in On Lok’s Program of All-Inclusive Care for the Elderly (PACE for “frail, community-dwelling elderly individuals” age 55+ who are eligible for nursing home care) and Acute Care for the Elderly (ACE) units in hospitals “ideally suited” for “Adults 70 and older requiring hospitalization.”  (Note: UCSF’s ACE uses Acute Care for Elders.)   

Outside of medical settings, “the elderly” refers to older people who need personal care assistance with activities of daily living (e.g., Residential Care Facilities for the Elderly) and/or risk losing basic needs (e.g., Legal Assistance to the Elderly “who are at risk of losing their housing, healthcare or income, or are victims of physical or financial abuse.”).

However, Miami University Gerontology Professor Kate de Medeiros stated, the term the elderly “should be retired for good – a blanket label that demeans an entire demographic group as frail and vulnerable based only on chronological age.” Similarly, Successful Aging columnist Helen Dennis suggested, “Since ‘elderly’ may suggest an image of decline rather than vitality, it may be timely to eliminate that term and instead use ‘elder.'” 

Senior, when used as an adjective, appears to be ok: Senior Community Service Employment Program, Senior & Disability Action (advocacy group); senior care/center/discount, etc. In 2014, National Senior Citizens Law Center changed its name to Justice in Aging, with tagline “Fighting Senior Poverty through Law.” Senior as noun referring to person remains commonplace, such as Community Living Campaign’s tagline “Cultivating connections to help seniors and people with disabilities age and thrive at home”; Meals on Wheels SF “allows thousands of seniors to live in their homes with dignity and independence as long as possible”; Self-Help for the Elderly provides “care for seniors to promote their independence, dignity and self-worth.” 

Senior Citizen is less commonly used, though National Senior Citizens Day on August 21, has maintained its name since its 1988 proclamation by 77-year-old President Reagan.  Also, in August 2020 issue of The Gerontologist, Jung Shin Choi wrote how senior cohousing community (SCC) “reduces the level of public expenditures for senior citizens” (p. 984).  

Navigating COVID-19

https://www.npr.org/2020/07/28/896134292/covid-19-etiquette-6-common-conundrums-and-a-printable-pocket-guide

According to SF Department of Public Health (DPH) COVID-19 data tracker based on 386,827 test results reported: 9,494 positive cases and 83 deaths (65% male; 51% age 81+, 20% age 71-80, 16% age 61-70, or 87% of deaths age 60+; 35% Asian, 28% Latinx, 19% White, 10% Black; 1% homeless).  Caveat: Due to this month’s statewide reporting failure to account for more than 300,000 cases, COVID-19 testing and case data were underreported and still being verified.  State DPH Director resigned after revelation of this backlog, which impacted ability of local public health departments to receive lab results to investigate and contact trace. 

Effective today, California’s reopening scheme now assigns a color tier (similar to AirNow Quality) for each county’s risk level based on rate of new cases per 100,000 residents per day (7-day average with 7-day lag) and %age of positive COVID-19 tests (no longer using hospitalizations as risk indicator):  purple “widespread”; red “substantial”; orange “moderate”; and yellow “minimal.”    

However, SF is playing it safer by continuing to base reopening decisions on 5 key public health indicators, also based on colors indicating where we are in relation to targets: red (far off); orange & yellow (not meeting); and green (meeting).  SF has never met 90% goal for contact tracing, which is why I think enforcement of preventive measures (masking, distancing) is needed. 

While out in public, I’ve taken photos of all ages violating masking orders (just like how I’ve taken photos of staff smoking outside health centers, in violation of SF ordinance), but SF is not taking enforcement actions against individuals.

Residents in highly politically polarized countries like U.S. (52%) and U.K. (54%) expressed the greatest dissatisfaction over their governments’ handling of COVID-19 pandemic.  Polarization results in each side getting “stuck” in tribal warfare, where people don’t have to critically think about their own bias and examine facts, easier to spout zero-sum arguments like save/sacrifice economy v. human lives? It takes thoughtful consideration of data, science, facts, risk analysis from different disciplines (that assign different meanings to words!) to figure out reasonable adaptations so economy can operate safely and while protecting lives.  In the meantime, we’re all vulnerable but frail older people are more vulnerable to severe COVID-19 as well as policies that continue to isolate them in LTC facilities.  Need to get “unstuck” and move forward! 

At this month’s Gray Panthers meeting, Arlie Hochschild discussed bridging the political divide between progressives and conservatives, based on her book, Strangers in Their Own Land: Anger and Mourning on the American Right (2018).  She wrote her book following Trump’s election to U.S. Presidency, and now he is seeking re-election in an even more polarized nation.  Older white voters might determine the Presidential election again.  As a self-described “liberal” Berkeley sociologist, Arlie has acknowledged that the far left can be less tolerant of hearing and learning world views that differ from their own.  She suggested American Exchange Project, a domestic “study abroad in your own country” which has been adapted for virtual experiences during this pandemic.

Sadly, many college campuses are coddling students who demand safe spaces and cancel culture, prioritizing feelings over thinking about topics that “trigger” discomfort to their self-esteem. How about reading Hillbilly Elegy: A Memoir of a Family and Culture in Crisis (2016) for insider’s perspective by J.D. Vance, who was mentored by Tiger Mom? How about more intergenerational engagement? Also, simulation exercises might teach empathy, like teens who dressed as grandmas to buy alcohol, so store clerks would not ask them to show IDs; one teen reported that one store owner was worried she wouldn’t be able to carry the bottles herself. 

While physically stuck indoors until smoke clears, I remain thoughtfully awoke.

“Treat others as human beings

Have a generous interpretation of their views

Allow them to clarify before shaming

Don’t judge their motive or group they’re in

Treat others the way you would like to be treated

This leads to understanding

Above all, practice humility

When arguing with a fool, make sure they’re not doing the same thing”

--John Dickerson,” Learn to argue better,” CBS News (Sep. 7, 2018)